MECIR: the bits that reviewers keep getting wrong! Cochrane Skin Editorial Base

Who knows what MECIR is?

MECIR = a list of methodological expectations that all Cochrane Reviews and Protocols need to meet to allow for publication. These are referred to as the MECIR standards: Methodological Expectations of Cochrane Intervention Reviews

Why is MECIR important? Quality: improves and maintains the quality of Cochrane Reviews. Standards: helps authors adhere to standard methodological practices (e.g. the inclusion of GRADE). Expectations: clear and transparent expectations of review conduct and reporting.

Where to start The MECIR standards are presented in one document. Different sections – for each stage: Protocol Review Update

Originally... 2 sections: Conduct of new reviews Reporting of new reviews Originally... 2 sections:

Now... 4 sections: AND Conduct of new reviews Reporting of new reviews Reporting of protocols for new reviews Planning, conduct, and reporting of updates Each standard pre-fixed with ‘C’: C1, C2, C3, etc. Each standard pre-fixed with ‘R’: R1, R2, R3, etc. Each standard pre-fixed by ‘PR’: PR1, PR2, etc. Each standard pre-fixed by ‘UR’: UR1, UR2, etc.

Do I have to implement all of the standards?

No! The standards are labelled either Mandatory or Highly Desirable. You have to implement the mandatory standards.

If you take one thing away from this presentation... We will not accept a submission for peer review unless it meets the mandatory MECIR standards.

Even if you started your review before MECIR was released, you need to meet the mandatory standards. The mandatory standards are the criteria that the editorial base check submissions against.

The bits reviewers keep getting wrong

1. Search date must be less than one year old at publication

Search date must be less than one year old at publication What is mandatory: C37 Rerun or update searches for all relevant databases within 12 months before publication of the review or review update, and screen the results for potentially eligible studies. What is highly desirable (and our preference): C38 Fully incorporate any studies identified in the rerun or update of the search within 12 months before publication of the review or review update. Why? The incorporated search date is the date to which the conclusions of the review are valid.

2. Summary of findings (SOF) tables Choose one main comparison from the review for the main SoF (you can also have additional SoFs) Choose up to 7 outcomes to include in the SoF (avoid multiple time-points) Assess the quality of evidence for each outcome (GRADE): risk of bias, imprecision, inconsistency, indirectness and publication bias Present the effects or impact of the intervention (relative and absolute) – for dichotomous and continuous outcomes MECIR standards: C23, C74, C75, PR39, PR40, R97, R98, U11, UR5. SOF: Ryan R, Santesso N, Hill S (2016) Preparing Summary of Findings (SoF) tables. Cochrane Consumers and Communication Group, available at http://cccrg.cochrane.org/author-resources. Version 1.0 June 2016. GRADE: http://training.cochrane.org/path/grade-approach-evaluating-quality-evidence-pathway

Outcome – name, length of follow up, scale Provide setting of intervention Footnotes to justify downgrading Risk and relative effect for dichotomous outcomes Include even if no or limited data – use comment box or footnotes Use risk boxes for continuous outcomes (not relative effect) Include adverse events Higgins JPT, Green S (editors). Cochrane Handbook for Systematic Reviews of Interventions Version 5.1.0 (updated March 2011). The Cochrane Collaboration, 2011. Available from www.Cochrane-handbook.org.

3. Reporting on all key outcomes (all primary outcomes and key secondary outcomes)

R12 ‘Report findings for all important outcomes’

R98 ‘Assessments of the quality of the body of evidence R98 ‘Assessments of the quality of the body of evidence...for each key outcome’

Anchor results to your important outcomes. Make it clear that you have reported on your key outcomes.

4: Differences between protocol and review

Choose the appropriate section! Document aspects of the protocol that were not implemented (e.g. because no studies, or few studies, were found) in the section ‘Differences between protocol and review rather than in the Methods section. Choose the appropriate section!

What to include New methods used Non-implemented methods Explain changes in methods: where and why Remember! Whether an update or review, you are always looking for differences from the protocol.

So if you want your review accepted… You must implement the mandatory MECIR standards Your search date must be less than one year old at publication At least one summary of findings table is highly desirable, and GRADE assessment is mandatory Report on all key outcomes Report on changes to what you planned

Where to find MECIR http://methods.cochrane.org/mecir

Where to find MECIR On the right hand side in RevMan (though this might not yet be up-to-date with the new standards)